AB0327 CARDIOVASCULAR RISK ASSESSMENT IN RHEUMATOID ARTHRITIS WITH CAROTID ULTRASONOGRAPHY AND CARDIOVASCULAR RISK SCORES: A CASE CONTROL STUDY
Authors: R. González Mazarío, P. Martinez Calabuig, J. J. Fragío Gil, E. Grau García, C. Pávez Perales, S. Leal Rodriguez, C. Riesco Barcena, A. V. Huaylla Quispe, L. Mas Sanchez, P. Muñoz Martinez, J. E. Oller Rodríguez, E. Vicens Bernabeu, F. Ortiz-Sanjuán, R. Negueroles Albuixech, M. De la Rubia Navarro, I. Martínez Cordellat, L. Gonzalez Puig, J. Ivorra Cortés, C. Nájera Herranz, I. Cánovas Olmos, J. A. Román Ivorra
Journal: Annals of the Rheumatic Diseases (2022)

Background The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than individuals from the general population. This excess risk might be explained by the chronic inflammation. Objectives To assess the Cardiovascular Risk (CV) in Rheumatoid Arthritis (RA) patients using the Framingham Score, SCORE (systematic coronary risk evaluation) and carotid ultrasound additionally to the traditional cardiovascular risk factors. Methods A single center case control study was performed. Inclusion criteria were adult RA patients (cases) and matched healthy adults in terms of age, sex, and CV risk factors (controls). Population over 75 years old, patients with established CV disease and/or stage III chronic kidney disease were excluded. Controls with other inflammatory diseases, pregnant women or any malignancy were also excluded. This study was performed from July-2019 to January-2020. The US study included presence of plaques, plaque number and measurement the intima-media thickness in both right and left carotid. Scores were multiplicated x1.5 according to EULAR recommendations. Results Overall, a total of 200 cases and 111 healthy controls were included in the study. Demographical and clinical variables were comparable between cases and controls and are shown in Table 1. In both groups a relationship between age, BMI and high blood pressure was detected (p&lt;0.001). RA patients had a Disease duration of 18.93 years (11.36); 163 (81.5%) Erosions (X-Ray of hands/feet), Extra-articular symptoms 44 (22%), Prednisone use 103 (51.5%) with Median dose of Prednisone last year 2.34 (2.84). In treatment with Methotrexate 104 (52%), bDMARDs 89 (44.5%) and JAK inhibitor 26 (13%). US study revealed a higher IMT in both right and left carotid arteries with greater presence of plaques in patients than in controls (CI 95% [1.542; 3.436], p&lt;0.001). Plaques were found in both carotid arteries in the 32% of cases and 9.91% of controls. The longer duration of RA was related to a higher presence of carotid plaques (95% [1.015; 1.056], p&lt;0.001). US and blood test results are shown in Table 3. SCORE and Framingham correlated with the CV estimation with US (p&lt;0.001), however, seemed to underestimate the global findings in cases (p&lt;0.001). Table 1. Demographic, clinical characteristics, Ultrasound Results, SCORE and Framingham of patients and controls. Characteristic RA cases n=200 Healthy controls n=111 Age - years 62.05 (10.75) 58.3 (12.14) Female sex – number (%) 163 (81.5) 73 (65.77) BMI – value (ds) 26.38 (5.03) 26.2 (5.19) Smoking habit Never Smoked 107 (53.5%) 71 (63.96%) Ex-smoker 51 (25.5%) 20 (18.02%) Active smoker 42 (21%) 20 (18.2%) Race – number (%)Caucasian 186 (93) 62 (93.94) Comorbidities – number (%) High blood pressure 83 (41.5%) 34 (30.63%) Dyslipemia 93 (46.5%) 39 (35.14%) Blood pressure -- mmHg 127.2(18.36)/78.67(10.21) 127.77(19.42)/78.28 (10.59) Ultrasound findings Right carotid cIMT 0.78 (0.15) 0.62 (0.11) Left carotid cIMT 0.77 (0.14) 0.64 (0.12) Plaques 101 (50.5%) 32 (28.83%) Bilateral 64 (32%) 11 (9.91%) Right carotid 17 (8.5%) 7 (6.31%) Left carotid 20 (10%) 14 (12.61%) SCORE Very Hihg 13 (6.5%) 5 (4.5%) High 31 (15.5%) 15 (13.51%) Low 156 (78%) 91 (81.98%) Framingham High 76 (38%) 33 (29.7%) Low 124 (62%) 78 (70.3%) Conclusion Cardiovascular risk calculators such as Framingham and SCORE are useful in RA risk estimation. However, those tools may underestimate the real risk, so carotid US might be valuable. Disclosure of Interests None declared